Interview by Christopher Coghlan
Anna Herforth attended Cornell University for undergraduate studies where she received a B.S. in Plant Science, summa cum laude in 2002. She attended the Tufts Friedman School of Nutrition Science and Policy where she completed her M.S. in Food Policy and Applied Nutrition in 2005, with a specialization in nutrition interventions. Anna returned to Cornell in 2006 and received a Ph.D. in International Nutrition in 2010. She has worked in several countries in Africa, South Asia, and Latin America. She currently holds a position at the World Bank as a Nutrition Specialist on multisectoral issues of nutrition, agriculture, and the environment.
In The African Food System and its Interaction with Human Health and Nutrition, you discuss the strong correlation between households with home gardens and consumption of fruits and vegetables. Would you please discuss the additional benefits that home gardens bring to families?
I think the main issue is that many smallholder farmers and rural families in sub-Saharan Africa don’t have the convenience of being able to get to a market quickly, especially a market that has a wide diversity of foods. So, what happens is that they might only be able to get to a market on a weekly, or monthly, or semi-monthly basis to get their necessities. The farmers I worked with in East Africa would often buy corn meal, salt, sugar — things they would not normally produce at home. If they only go to a market every week, two weeks, or month, they really can’t provide their families with fresh vegetables except on the day that they went to the market because they also generally don’t have access to refrigerators. Thus, the argument for having diversified production — which includes home gardens — is that it presents instant access to a more diverse diet than farmers may have if they have to rely completely on the market.
Do you believe there is an inherent tension between greater numbers of home gardens and industrial food production in developing countries? Would you agree that nutrition and dietary diversity suffer when a large percentage of food comes from commercial rather than family or local sources?
I think of that issue more in terms of the food system of a place: whether the place in question depends on a large number of small producers or a few industrialized producers like we have in this country. The majority of malnourished people in sub-Saharan Africa are in smallholder farmer households, who make up the majority of the rural poor.
Often, industrial production touches them indirectly in the sense of the economy in general, food prices, and the prices they can get for the products that they sell. The food security of a smallholder farmer household will depend basically on two things: what they can produce for themselves on their own farm, and the income they can get from that production.
And when you talk about the income, you need to ask questions such as: Who in the household is controlling that income? Is the income from one large sale a year? Or, are they producing something they can sell periodically so they have a regular flow of cash? Are women able to generate income and spend it as needed (which, by the way, is usually good for nutrition)? What are the most easily accessible foods, in terms of convenience and price? It does seem clear that greater dependence on a food system centered on industrial production is more linked to nutritional problems like obesity. Therefore, it’s a very complex question, and depends on the circumstances.
In Promotion of Traditional African Vegetables in Kenya and Tanzania, you make reference to a 2007 World Bank review that “summarized five main pathways through which agriculture affects nutrition: home consumption, income generation, women’s empowerment, lower food prices, and national macroeconomic growth.” Would you please outline each of these paths and highlight their strengths and weaknesses in improving nutritional outcomes?
That’s a big question — I can’t promise to be exhaustive but I can make a couple of points. I think in past decades people had a lot of faith in using agriculture as an engine of economic growth in developing economies, which would then trickle down to affect the nutrition of all people in the nation or the region.
But I think to a large extent that has been challenged. There is a caveat to that: it is true that richer countries have, in general, lower rates of undernutrition, and undernutrition goes down as individual countries become richer. However, the correlation is much less perfect than you would expect, which is why we say that large scale economic growth is helpful but not sufficient.
Likewise, just increasing the amount of food available without concern for nutritional quality or what kind of food is accessible, does not solve malnutrition. That is where more household level aspects come about, in terms of own food production, income generation, and the empowerment of women within the household. Those are the places where you can affect things very directly by improving the immediate access households have to food, either through what they can buy or what they can grow for themselves, and to health services. Those decisions have a lot to do with women’s empowerment.
In the same piece, you also state that “three other pathways from agriculture to nutrition are apparent, but have not been emphasized in most agriculture-nutrition interventions or literature.” Would you please provide an example of one of these pathways and elaborate?
The basic idea is that agriculture and food security depend on a functional ecosystem. Intuitively, they require fertile soil, adequate water, and clean water; you have to have reliable seeds, and a diversity of seeds and species that can be productive in varying environmental conditions, especially as climate change starts to show some effects. So, these are the ecosystem services that are the foundation for food security. They are affected by agriculture and agricultural practices, and will in turn directly affect nutrition.
The policy brief Scaling Up Nutrition: A Framework for Action states that there are “two complimentary approaches to reducing levels of malnourishment: direct nutrition-specific interventions and a broader multi-sector approach.” Could you please discuss each approach and comment on how they can work together successfully?
Over one hundred multilateral institutions, bilateral agencies and NGOs have endorsed the scaling up nutrition framework, so it has broad consensus amongst the nutrition community. Nutrition-specific interventions include nutrient supplements to affect micronutrient deficiency (or hidden hunger) directly, such as vitamin A supplements, and iron folic acid supplements for pregnant women to prevent anemia, or therapeutic feeding for children identified as malnourished.
Those interventions are very direct and affect specific nutrition problems. The necessary “nutrition-sensitive” policies or activities are more fundamental to good nutrition in a population, but are less direct: having good water; sanitation; sufficient food production; consistent access of all people to a sufficient diet, women’s empowerment; environmental resource management; education for all. All of these lead to good nutrition, but do not directly address a clinical problem in an individual.
So, these kinds of policies are needed in agriculture, education, water and sanitation, but there isn’t a consensus so far on exactly what to do or how we can implement them, unlike nutrition-specific interventions where there is an emerging consensus. The nutrition community is really working now to try to provide a menu of options to address some of these more fundamental issues affecting malnutrition in multiple sectors. That is what I am working on at the World Bank.
Scaling Up Nutrition also references a 2009 study carried out for the World Bank that identified a selective package of evidence-based direct interventions to prevent and treat undernutrition. These interventions included “promoting good nutritional practices, increasing intake of vitamins and minerals with provision of micronutrients for young children and their mothers, provision of micronutrients through food fortification for all, and therapeutic feeding for malnourished children with special foods.” The policy brief suggested that these interventions would have a significant impact on the UN Millennium Development Goals. Could you please discuss how these interventions would help countries realize the goals set by the UN?
Every intervention you just listed is a nutrition-specific intervention, which has general endorsement by the international nutrition community as actions that will help greatly. They are interventions that we know will reduce mortality, for example; they are easy targets.
However, even though we know these interventions will do something immediate to reduce malnutrition, there is not enough funding or action globally for them to be done, let alone the various nutrition-specific interventions in other sectors necessary to set the foundation for good nutrition. That’s why the consensus is important: to raise awareness and secure funding from not only international aid organizations, but national governments as well.
Nutrition is fundamental for economic development and for the health of a nation, so allocating some money for these very cost effective, very cheap interventions to address malnutrition would do a great deal of good.
Which policy intervention that you work on currently that is supported by the World Bank or other international organizations do you see as potentially groundbreaking for improving nutritional outcomes?
One jumps to mind immediately: in the agriculture-nutrition connections that are now increasingly being made, the World Bank and other development institutions are starting to focus on smallholder farmers rather than relying solely on large-scale production for food security. Another related intervention is reaching women farmers. Targeting smallholder and women farmers will reach the most vulnerable populations in general for food insecurity and nutrition, in terms of rural populations that are present in large parts of sub-Saharan Africa and other regions. So, focusing on those groups is something that will bring important changes, as it has not been emphasized as much in the past.
How did your time at Cornell prepare you for work with the World Bank? What advice would you give to young professionals who are looking to begin a career in agriculture and nutrition?
Cornell is an ideal place to begin a career in agriculture and nutrition because there are so many resources available, professors who have experience in working across boundaries, and projects in which graduate students can get involved for their thesis work.
For example, the Food Systems’ Integrative Graduate Education and Research Traineeship (IGERT) grant allows graduate students to work on multi-sector projects for their graduate work. Groups such as FANG (the Food, Agriculture, and Nutrition Group), which I helped to create, bring students and faculty together on common issues across disciplines. So there are many hands-on opportunities, in addition to fantastic faculty and traditions in both international agriculture and international nutrition.
That is how Cornell helped me: it exposed me to all of those things and provided me with a wonderful mentor, Cornell Institute for Public Affairs (CIPA) Core Faculty member Per Pinstrup-Andersen, who has spent his career working across boundaries in agriculture, nutrition, and poverty reduction.
I think all the opportunities for travel also prepared me to work at the World Bank where a concrete understanding of the contexts and issues in various settings around the world is extremely valuable. Students who can seek and take advantage of those opportunities will really have an advantage when they graduate and start looking for jobs in international development.
Christopher Coghlan graduated from the Cornell Institute for Public Affairs with a Master of Public Administration, concentrating in Public and Nonprofit Management. He received a Bachelor of Arts from the University of Toronto in 2004 and a Master of Environmental Studies from York University in 2006. While enrolled at Cornell, Christopher took part in agriculture and environment projects in both Nepal and Switzerland.